I need a general answer here, just a medical opinion on this matter.

Hi,
I got a question about a 71 year old man who was being prepared for
colon surgery due to a growth in colon (possibly cancer... the bladder
was being affected also by the growth.).
The doctor said he would first consider cleaning the colon by giving
the patient Epsom salts in part doses for a day or 2 and then try a
rejoin after cutting the growth.   Only if that did not work he would
have performed a colostomy.
He had stents placed in the patient kidneys on the Monday.  Then
overnight the patient experienced complete intestinal obstruction
noted by abdomen swelling and an anxiety attack.  The doctor said the
next morning that an emergency colostomy surgery was required.  4
hours later just before surgery the doctor said his chances of
survival were slim.  He never regained consciousness and died 36 hours
later.
Firstly, I don?t think it was necessary to perform a separate surgery
to place stents in the patient and then plan for another surgery later
in the week to remove the growth especially seeing that the patient
was 71.
Secondly, I suspect that this first surgery (to insert the stents)
could have caused the obstruction! After all he was on liquids only
for the pass couple days and the growth itself could not further
develop in that space of time.
Finally, the doctor only observed the patient for obstruction twice a
day.  I think he should have had the nurses do so more often
especially seeing he was being given Epsom salts which I figure could
have also unintentionally worsen the obstruction.

My question is, does this seem to be a malpractice situation? (This
incident did not occur in the US and I know laws related to
malpractice may vary, so I just need a general answer here.)

Thanks a lot.

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Clarification of Question by mark05-ga on 27 Aug 2005 13:09 PDT

Thanks for the comments.

Actually a colonoscopy was done at the beginning and a biopsy sample
was sent for testing.  I did not receive the biopsy report from the
lab as yet.  Will collect that soon, but I understand the point that
only cancers would spread to organs like that.
From the colonoscopy the doctor was able to confirmed that there was
serious (but not complete) blockage of the colon. A CT scan was done
the afternoon after the stents were placed in.
Because of the spread to the bladder, the patient was hocked into an
irrigation system to keep the bladder form contamination. Antibiotics
were also administered to prevent infection.
My concerns are the possible oversight on the nursing home and
doctor's part in not properly monitoring for complete blockage of the
colon since by the time they picked up on it, things were already to
adverse. Also the query of why would complete obstruction happen
overnight.
The comment made that removing the obstruction should have been a
priority is something I would agree with, especially after reading on
how dangerous this condition is.

Well the old rule goes that anyone can sue anybody for anything.
However in this case it does sound like the physician did not follow
the patinet closely enough in recovery but that could only be
determined via progress notes made by himself or the nurses. Having
worked with GI doctors on clinical research studies I find it dubious
that the Doc did not first remove the obstruction as that seemed to
take high priority at the time (though I would wonder why a
colonoscopy was not perfromed first to get a good view of the
obstruction and biopsy it first before surgery) The stents were placed
I imagine to protect the kidneys from shutting down due to blood loss
but I cannot be sure based on the description. As for the stenhts
causing the obstruction it is possible that during that surgery
something could have become diloged causing the obstruction but that
is mere specualtion on my part. I think however that I would seek
legal assistance just to have a review of the procedure and recovery
notes I'm sure the hospital (if it's worth it's salt) has already done
a complete reveiw during a monthly morbidity and mortality reveiw.

Hi.. I have some points:
1. A growth originating from the colon and also affecting the urinary
tract is not "possibly" cancer, it can actually be nothing else than
cancer. If anybody was told that it "possibly" is cancer, I suspect
that this was because the growth was only seen on a CT or something
and not histologically confirmed with a biopsy (which would be done
during the operation or could be done during coloscopy). The biopsy is
what is legally needed to establish a diagnosis of "cancer".

2. As the tumor was already growing out of the lumen of the colon, the
operation would be paliative anyway. As the cancer invades the
peritoneum (the inner surface of the abdomen), it can spread on it to
any place in the abdominal cavity... the peritoneum is to cancer cells
like the soil is to plants .. they can grow on that.

3. The stents were placed in the kidneys (or ureters?) possibly
because there was a danger of renal failure if the urine flow was not
maintained. If the tumor was blocking the urine flow, there could be
marked azotemia and other signs of renal insufficience already, and
this MUST be treated BEFORE the big operation as any condition like
this actually kills the chances of survival in the operation.

4. I recommend obtaining an autopsy report. That should state the
cause of death and it could also clarify the reason for the intestinal
obstruction. The autopsy will also show the extent of the disease.
With the autopsy report (which is the most important), and any other
documentation you can get, find a doctor - someone you trust - and
consult the case with him prior to going to a lawyer (who will
definitely want to earn some money .. if you are not in the US you
will pay him even if you lose).

However, as I read your explanations, I didnt find any apparent
mistake in what the doctors did. The operation you complain about
(stents) -- if it actually was necessary, it MUST have been performed
BEFORE the colon resection. The necessity of this operation can be
told from the laboratory results prior to this stents operation.

My last comment is on the whole thing - if I was 71 years old and had
cancer growing already THROUGH my organs, I would like to die fast.